Nasogastric intubation

meeting nutritional needs

1. Definition It is the insertion of a tube into the oesophagus and stomach through the nose It is defined as the passage of single or double lumen tube through the nose or mouth to stomach for the purpose of the drainage, instillation, decompression, lavage or performance of diagnostic tests.

2. Purpose To feed the patient with fluids when oral intake is not possible To dilute and remove consumed poison To instill ice cold solution to control gastric bleeding To prevent stress on operated site by decompressing To relive vomiting and distension To collect gastric juice for diagnostic puposes

3. Safety Therapeutic effectiveness Comfort Use resources Good workmanship Individuality Anatomy and physiology Microbiology Nutrition Pharmacology Physics Chemistry Psychology Sociology Principles Nursing principles Scientific principles

4. Indications Patient who cannot eat (GIT functioning normally) Comatose patient Mechanically ventilated Patient who will not eat Patients who refuse to eat Elderly Disoriented patients Patients who cannot maintain adequate oral nutrition Patients with infection, trauma, cancer etc. Surgery

5. Contraindications Gastric surgery Ulcers Tracheoesophageal fistula Oesophageal surgery Polyps in nose , recent nasal surgery, facial surgery Deviated nasal septum Patient on anticoagulant therapy

6. General instructions Remove the dentures ( to prevent it from dislodging and blocking the respiratory tract) A rubber tube may be placed in a bowl of ice to cool and stiffen Lubricate the tube While removing the tube, pinch the tube and pull it out gently and quickly (so that the fluid may not trickle down the pharynx ) During introduction of the tube never use force (it may cause injury to mucus membrane) Watch the complications ( nausea, vomiting, distension, diarrhea, aspiration, pneumonia etc.)

7. Articles Purposes A try containing Mackintosh with towel To protect the bed and linen A Ryle’s tube (8-12 Fr ) in a bowl containing cold water To make the tube hard and easy for insertion Cotton tipped applicator, Saline or soda bicarbonate solution To clean nostrils Lubricant (liquid paraffin or glycerine) To prevent friction between mucus membrane and tube Adhesive plasters and scissor Fix the tube in position A bowl of water, stethoscope, syringe (10-20cc) To test the location of tube A kidney tray and a paper bag To collect waste

8. Ryle’s tube Flexible rubber or synthetic material Transperant or opaque Length : 36-50 inches Gastrostomy tube: 12-15 inches The lumen is measured by French (Fr) When no is lower the inside diameter of tube will be smaller

9. Ryle’s tube Parts Tip Drainage port / lateral eyes Radio opacity ……..radio opaque line/strip Body Markings: 50cm---stomach 60cm---pylorus 70cm---duodenum Base

10. Polyurethane NG tube ( Viasys Corflo ), 8 Fr × 36 in (91 cm).

11. Preliminary assessment Check Doctors order for any specific instruction Patient ability to follow instructions General condition of the patient Articles available in the unit

12. Preparation of patient and unit Explain the sequence of procedure Arrange the articles at the bed side Provide privacy Provide comfortable position (fowler’s position , comatose patient semi-fowlers position) Place the mackintosh and towel across the chest Remove the dentures Give mouth wash and help him to clean the teeth Clean nostrils

13. Procedure

14. Method to confirm NG tube in the stomach Aspirate: attach the syringe to the end of NG tube and aspirate small amount of gastric content Immerse distal end of tube into bowl of water and check for air bubbles Auscultate : attach syringe to free end of the tube, place diaphragm of stethescope over left hypochondrium .inject 10 ml of air and auscultate abdomen for gushing sound. X ray

15. After care Offer a mouth wash . Clean the face and hands and dry them Remove the mackintosh and towel Make the patient comfortable in bed Take all articles to the utility room discard the waste, clean it and replace it in a proper place Wash hands Record the procedure

16. NG TUBE FEEDING (GASTRIC GAVAGE)

17. Definition Nasogastric tube feeding is given through tube which is inserted through patient’s nose into stomach when patient is unable to take food orally It is a process of giving liquid nutrients or medications through a tube into the stomach when the oral intake is inadequate or impossible

18. Gastric gavage it is an artificial method of giving fluids & nutrients through a tube, that has passed into the oesophagus and stomach through the nose, mouth or through the opening made on the abdominal wall, when oral intake is inadequate or impossible

19. Indications Unconscious Client with psychosis Swallowing difficulties Chronic infections Anorexia nervosa

20. Advantages An adequate amount of all types of nutrients including distasteful foods & medications can be supplied Large amount of fluids can given with safety It can be continued weeks with out any danger The stomach may be aspirated at any time of desired Overloading of the stomach can be prevented by drip method

21. Principles A thorough knowledge of the anatomy and physiology of digestive tract and respiratory tract , ensures safe induction of the tube Microorganisms enter the body through food and drink Mental and physical preparation of the patient facilitate introduction of the tube Systematic ways of working adds to the comfort and safety of the client and help in the economy of material, time and energy

22. Preliminary assessment Identify the correct patient Check the doctor’s order Check the level of consciousness Check whether feed is ready at hand Articles available in the unit

23. Preparation of patient and environment Explain the sequence of procedure Provide adequate privacy Position (sitting or semi fowlers) Place mackintosh and towel around the neck Arrange the articles at the bed side locker Clean the mouth by providing mouthwash

24. Articles A tray containing Mackintosh and towel 50cc syringe/ feeding tube and 5cc syringe Stethoscope Bowel with water Adhesive with scissors Feeds and water Ounce glass Kidney tray

25. Procedure Wash hands Place towel around the neck Ensure the tube is in the stomach Remove plunger from syringe…………..Pinch tube to prevent air entry……….Remove spigot….connect syringe to the tube. Keep syringe about 12 inches above patients head. Start feed with small measured amount of water and allow feed to follow slowly and steadily through tube in such a way, that air does not enter tube Do not force fluid, allow to flow by gravity At end of feed flush tube by pouring small measured amount of water …..remove syringe and replace spigot

26. After care Remove towel Place the patient in comfortable position Replace the articles to utility room, clean it and replace it Record the procedure in nurses record and intake out put chart.

27. Gastrostomy feeding Jejunostomy feeding

28. Gastrostomy feeding : feeding is given through an artificial opening made surgically into the stomach through the abdominal wall for feeding purpose when the patient is not able to swallow through oesophagus.

29. Jejunostomy feeding : Jejunostomy  is the surgical creation of an opening (stoma) through the skin at the front of the abdomen and the wall of the  jejunum (part of the  small intestine ) A jejunostomy is an alternative to a  gastrostomy   . The advantage over a gastrostomy is its low risk of  aspiration due to its distal placement

30. Doubt Discussion

31. Thank you